From "Anna O." to Bertha Pappenheim: transforming private pain into public action

Bertha Pappenheim ("Anna O,") was treated for hysteria by Josef Breuer when she was a young adult. As a mature adult she became a leading social worker, writer, and feminist activist in the German Jewish community. This article examines her therapy with Breuer, her own struggle for recovery, and some links between her earlier and later life, in particular the lack of intimate relationships in her life and her work against the victimization of women. Throughout the article psychoanalytic interpretations, social history, and feminist analyses are integrated to provide a contextualized examination of Pappenheim's life.     

The choice of a name: "Dora" and Freud's relationship with Breuer

I have suggested that Freud's choice of the pseudonym Dora for his eighteen-year-old hysterical patient, Ida Bauer, was over-determined. Dora, it seems likely, was named not only after Freud's sister's nursemaid, as Freud himself explained, but also after Dora Breuer, Josef Breuer's youngest daughter. This theory is based on an examination of the similarities in the lives and symptoms of Anna O. (Breuer's famous hysterical patient of 1880-1882) and Dora; on an analysis of the transferences and countertransferences in the cases of these two young women; and on evidences of the persistent significance of Josef Breuer in Freud's life after 1895. These specific inquiries also call attention to the nature of hysteria at the end of the nineteenth century and to the ever-present complexities of the physician-patient relationship.     

Freud's "Project": a theory for Studies on Hysteria

The controversy about the place of Sigmund Freud's unfinished draft of 1895, "Project for a Scientific Psychology," in the history of his thought, is addressed. It is argued that the "Project" may be understood as a suppressed response to the theory of hysteria presented by Josef Breuer in his and Freud's joint work, Studies on Hysteria. It is suggested that the "Project" may be read, in part, as a substitute for Breuer's theory. The timing and circumstances of the "Project's" composition are discussed. Its substantive and formal congruence with Studies on Hysteria is brought out. Freud's comments on scientific hypotheses are discussed, and it is shown that they constitute an implicit criticism of Breuer's theory.     

Revisiting Anna O.: a case of chemical dependence

The famous clinical case of Anna O./Bertha Pappenheim, who was treated by Breuer from 1880 to 1882 and whose pathology was discussed by him and Freud in an 1895 article (J. Breuer & S. Freud, 1895/1955), is reviewed based on biographical information regarding the patient, which appeared from 1953 onward. The objective of this article is to show that, in order to better understand the case, the diagnosis of chloral hydrate and morphine dependence, as well as that of mood disorder (primary or drug induced), has to be taken into account. The method used is a careful literature review. The conclusion is that, based on all available data disclosed in recent years, these 3 diagnoses should be considered in this case, which is the most studied one in the history of psychoanalysis.     

The case of Anna O.: a neuropsychiatric perspective

Previous interpretations have not adequately explained the presence of focal neurological signs, delirium, and a variety of highly specific disturbances of perception, language, and sensorium in the case of Anna O. Examination of the neurological details suggests that Anna suffered from complex partial seizures exacerbated by drug dependence, and that she developed conversion symptoms patterned after the preexisting organic pathology. Hysterical conversion symptoms that mimic ictal events are not uncommon in psychomotor epilepsy. Recent neuropsychiatric models of hysteria are remarkably similar to the hypnoid states theory Breuer formulated, based on his observation of Anna O. The hypothesis presented here does not conflict with previous psychodynamic interpretations. I submit that it was the development of a conversion disorder patterned on actual organic phenomena, which highlighted for Breuer and Freud the "psychical mechanism" of somatic symptoms, thus paving the way for the important psychodynamic discoveries for which the case is remembered.     

Peter Heller's a Child Analysis with Anna Freud: the significance of the case for the history of child psychoanalysis

A Child Analysis with Anna Freud, a collection of Anna Freud's detailed case notes of her treatment of the young Peter Heller between 1929 and 1932, was first published in English in 1990. Not only does this work give us direct access to Anna Freud's ways of thinking and working at a crucial period in the early history of child analysis; it is also one of the few records of an adult reflecting in depth on the experience of being in analysis as a child. Yet to date this work has received little attention in the psychoanalytic literature. In an attempt to redress this neglect, the Heller case study is placed in the context of Anna Freud's emerging ideas about child analysis. In particular, its significance in the development of her psychoanalytic thinking is investigated in the light of her 1927 book, The Technique of Child Analysis.     

‘It’s silly these doors don’t open’: a six-year-old girl emerges from a chronic state of emotional withdrawal

This clinical paper explores the way in which the first two years of a long-term psychotherapy helped six-year-old Anna to lessen her retreat into a chronic withdrawn emotional state. Over the course of the first year she would occasionally pick up the fridge from the doll’s house and try to open the doors, but because the fridge was actually a block of wood the doors could not open. In treatment, this inquiry came to represent the difficulties of engaging and making contact with a baby who found it very hard to feed. The author describes how, as Anna entered into a therapeutic relationship, it slowly became clear that there was an inner world jam-packed with persecutory anxieties and a family history of unmourned loss and trauma. Through fear Anna slammed the doors to her mind – to knowing herself – and by not feeding, Anna starved herself of opportunities for mental growth. It took some time for her to state, “it’s silly these doors don’t open, they should”. In the discussion of this clinical material the author draws on the work of Francis Tustin, Alessandra Piontelli and Marguerite Reid to consider the link between intergenerational and prenatal trauma and subsequent emotional disturbance in the child.     

Infantile sexuality: Its place in the conceptual developments of Anna Freud and Donald W. Winnicott

This essay explores the place of infantile sexuality in the theories of Anna Freud and Donald W Winnicott. Both Anna Freud and D.W. Winnicott incorporated and at the same time changed the classical psychoanalytic account of infantile sexuality and the instinctual drives. Whilst Anna Freud remained closer to her father's original conceptualization, she developed a multidimensional model of development which gave the drives a foundational status whist also maintaining their significance in giving meaning and texture to children's subjective experience. Winnicott also retained much of S. Freud's original theorizing except that in a fundamental way he turned it on its head when considering earliest development. For him the establishment of the self was paramount, and the drives and infantile sexuality merely served to give substance to that self.     

Pavlov,psychoanalysis, and neuroses

Pavlov’s discovery of experiment neurosis was serendipitous, yet it was made under the influence of Breuer and Freud’s case of Anna O. In 1914, Pavlov’s disciple N. R. Shenger-Krestovnikova, exploring the limits of visual discrimination in dogs, noticed that when the discrimination was difficult, the dogs’ behavior became disorganized. Pavlov drew an analogy between the condition of Shenger-Krestovnikova’s dogs and their disorganized behavior with Anna O.’s situation and her neurotic reaction. Pavlov concluded that he had demonstrated in the laboratory the elements of neurosis in animals and human alike. Schilder’s criticism of his position, his later study of human neuroses in clinical settings, and the views of Janet may have induced Pavlov to differentiate between animal and human neuroses.     

Anna Freud's Analysis by Her Father: The Assault on the Self

Sigmund Freud's analysis of his daughter, Anna, continues to create many troubling questions: For example, in terms of his own theory did Freud envisage the transference reactions of his daughter in her analysis with him? How are we to understand Anna Freud as a well-trained analyst in terms of the inevitable limitations of her analytic experience with her father? Menaker explores the ethical effects of this analysis in regard to fundamental problems in psychoanalytic theory and therapy.     

Anna Freud and Observation: Memoirs of Her Colleagues from the Hampstead War Nurseries

ABSTRACT

Initially, Anna Freud did not wish to carry out systematic observations; rather, she wanted to be in the field while maintaining an analytical attitude with a free-floating attention. Based on memories of her employees Manna Friedmann, Anneliese Schnurman, Hansi Kennedy, and Joyce Robertson, this article discusses the way in which Anna Freud taught them to observe the children. She also observed those very colleagues who were observing, in order to be able to convey to them, a psychoanalytic view of the children.     

‘We’re all poor nuts and things happen,and we just get mixed in wrong,that’s all’ lessons for psychotherapy from Eugene O’Neill’s play,Anna Christie

Anna Christie, by the Irish American playwright Eugene O’Neil, is a powerful play, depicting hurt emotions, injured selves and the hardened exteriors that people fashion to blame and afford a measure of protection. It relays the story of an abandoned daughter and her reunion with her father, their (relative) reconciliation, and meeting a new man, and the consequences of her revelation of prostitution. From textual analysis of the play, the paper explores themes of shame, repudiation and self-protection, including the formidable, or ultimate defence of ‘unassailability’. It is argued that the psychotherapist has something valuable to learn from this harrowing and evocative work of literature.     

Delboeuf and Janet as influences in Freud's treatment of Emmy von N.

An analysis is made of Freud's treatment of the patient known as Emmy von N. in which for the first time he used what he called "Breuer's technique of investigation under hypnosis." It is shown that the main component of Freud's therapy owed nothing to Breuer: the patient's traumatic memories were altered by direct suggestion under hypnosis. The abreaction which did take place seems to have resulted from Freud's expectation that it should occur. Two cases published by Delboeuf and Janet in late 1888 and early 1889 were treated by a then unusual method which analysis demonstrates to have been virtually identical to the technique used by Freud. Evidence is presented that the Delboeuf and Janet cases could have been known to Freud before he began his treatment of Emmy von N.     

The Controversial Discussions: Edward Glover and the Origins of "Double-Barrelled Training"

I attempt to rehabilitate Edward Glover's historical reputation, based on unpublished interviews as well as recently found documentary material. This should make one of the defining moments in the history of British psychoanalysis more plausible. Glover was an eloquent heresy-hunter - against Jung, Rank, Klein, Alexander, and others - yet the polemical side of him represents only one aspect of his career. During the Controversial Discussions Glover was taking some of the burden for the way his leader Jones had run the British Society. In moving against Klein, Glover felt he was fulfilling Freud's own wishes, and that he was allied with the recently arrived Viennese contingent. After Glover's resignation in 1944, Jones split the opposition by appointing Anna Freud as Glover's successor as IPA Secretary. Subsequently Adrian Stephen and Donald Winnicott opposed Glover's even being allowed to speak at a psychoanalytic conference in Amsterdam; Anna Freud defended Glover's presence then. Glover's long struggle to be accepted as a member of the Swiss Society only went through in 1949, when Jones ceased being President of the IPA. Glover and Anna Freud regularly corresponded about setting up of the distinction between the "B" and "A" groups within the British Society. Meanwhile Glover, who had since the early 1930s been the de facto founder of the Institute for the Study and Treatment of Delinquency, used his administrative talents there. He successfully founded The British Journal of Delinquency with Miller and Mannheim. Unlike what happened at the British Society, Glover cooperated without problem at the ISTD and the Portman Clinic. Glover was not only an important and successful clinical analyst but also a pioneer in forensic psychiatry. In 1947 he was unofficially approached and asked to take over the Directorship of the New York Psychoanalytic Training Institute. When the proceedings of the Controversial Discussions were published in 1991, various myths had been established about what had happened. That Glover found himself caught in the middle was not only a personal tragedy but also a part of a much larger story.     

Wandlerin zwischen den Welten

Anneliese Schnurmann belongs to the first generation of Anna Freud’s coworkers in the war nurseries and psycho-analytical child experts, as pediatric analytical training was called, which were established by Anna Freud. Although Anneliese Schnurmann later completed a training at the British Psychoanalytical Institute as an adult psychoanalyst, she remained a lifelong follower of Anna Freud’s concept. This might be due the fact that she had found a replacement homeland as had many emigrants from Germany and Austria in the circle around Anna Freud. Even during her time in Berlin, Anneliese Schnurmann, who was befriended with the Bonhoeffer family, established the “Jugendstube Charlottenburg” (Youth Home Charlottenburg) for unemployed youth, together with Dietrich Bonhoeffer.     

Anna Freud: The Hampstead War Nurseries and the role of the direct observation of children for psychoanalysis

The psychoanalytic tradition of direct observation of children has a long history, going back to the early 20th century, when psychoanalysis and the emerging field of 'child studies' came into fruitful contact in Freud's Vienna. As a leading figure in the attempted integration of direct observation with the new psychoanalytic knowledge emerging from the consulting room, Anna Freud played a crucial role in the emergence of this field. But her major contribution to the theory and practice of observing children came during the Second World War, when she founded the Hampstead War Nurseries. The author describes in detail this important period of Anna Freud's career, and discusses the impact it had on later work. He explores the theoretical contribution that Anna Freud made in the post-war years to the debate about the place of direct observation in psychoanalysis, and concludes that Anna Freud's 'double approach' (direct observation plus analytic reconstruction) still has a great deal to offer as a method of both psychoanalytic research and education.     

Anna Freud exposes herself to criticism. "The ego and and the mechanisms of defense" under the magnifying glass]

In the early 1970's members and guests of the Hampstead Clinic, under the guidance of Joseph Sandler, discussed Anna Freud's The Ego and the Mechanisms of Defence, which had been published in 1936, with its author. Elrod presents this discussion in excerpts and emphasizes the undogmatic approach to psychoanalytic theory evident in Anna Freud's and Joseph Sandler's contributions.     

Breaching the shame shield: Thoughts on the assessment of adolescent child sexual abusers

The author writes a personal memoire of her experience as an early trainee at the Hampstead Clinic. She continues with reminiscences of over thirty years of contact with Anna Freud.     

"Working through" and the novel

Prone to jargon, psychoanalytic literary criticism must be circumspect lest it appear narrow, sectarian, judgmental or exploit a particular psychoanalytic theory. Salient imagery, symbolism, metaphor, and psychologically intuitive characterization in the novel may be viewed as evocative of central, conflictual, predominantly unconscious source of experience or fantasy (Arlow, 1979) synchronizing with autobiographical and biographical data in achieving more dynamic, interpretive syntheses. VW's emotional state is an emergent of her total personality interacting with and evolving in her highly complex family milieu. Though she claimed writing the novel modulated the preoccupation with her parents, essentially VW did not resolve her obsession with the cumulative and untimely deaths of her parents and siblings but engaged in her writing in a perpetual mourning of these and other psychological losses for most of her life. Her life and work reflect the processes of "repetition" and "elaboration" also intrinsic to the psychoanalytic process but she did not achieve the memory "reconstructions" and "changes in self-esteem" alluded to by Kris (1956a, 1956b) and Greenson (1965) as intrinsic to the psychoanalytic experience of insight and "working through."     

The dreams of a cancer patient: a "royal road" to understanding the somatic illness

In this paper we have presented the principal dreams of a 39-year-old female patient in order to demonstrate how closely the dreams were linked with the understanding of her cancerous condition. The analysis, lasting over a period of eight years, ended with the remission of the patient's cancerous condition to the point where she was without pain and symptom-free. The findings suggested that her dreams played a special role in her analysis by providing important landmarks regarding her treatment's progress and state of her cancerous condition. In a general sense, it was concluded that the patient's dreams did provide a "royal road" to understanding her somatic illness. Specifically, it was concluded that, first, the patient's dreams were able to represent quite reliably, in symbolic form, the state of her cancerous condition; second, that the cancer condition and transference-countertransference reactions were closely entwined; and third, that each of the patient's dreams seemed to be introduced by a crisis situation connected with a traumatic early memory.